Preventing excess winter deaths and illness; the health risks - - PowerPoint PPT Presentation

Preventing excess winter deaths and illness; the health risks associated with cold homes

Centre for sustainable energy seminar 2015, Bristol David Sloan, Co‐chair of Public Health Advisory Committee

Context and overview Context and overview

• Poverty and inequity are health issues, so is fuel poverty
• Cold weather causes an increase in illness and death
• Policy and initiatives on carbon saving, public health,

housing, fuel efficiency and poverty and inequalities do not always align at national or local level not always align at national or local level

• Many organisations and sectors are involved
• So there is a problem; what can be done?
• So there is a problem; what can be done?

NICE k d t i th id d d

• NICE were asked to review the evidence and produce

guidance

NICE’s brief NICE s brief

• NICE was asked by the Department of Health to produce

evidence-based guidance on interventions to reduce excess winter deaths and illness associated with cold excess winter deaths and illness associated with cold homes, focusing particularly on

– Those people and groups who are vulnerable p p g p – An integrated approach to identifying people at risk and in taking action C l t t C ld W th Pl – Complementary to Cold Weather Plan

• Aimed not just at the NHS but also a much wider

audience local authorities commercial community and audience – local authorities, commercial, community and voluntary sector organisations

Daily deaths vs temperature Daily deaths vs. temperature

S E i t t lit i E l d d W l N 2014 N ti l St ti ti Source: Excess winter mortality in England and Wales. Nov 2014. National Statistics

Excess winter mortality in England Excess winter mortality in England

S E i t t lit i E l d d W l N 2014 N ti l St ti ti Source: Excess winter mortality in England and Wales. Nov 2014. National Statistics

Costs in illness and deaths Costs in illness and deaths

• On average there are about 25,000 extra deaths in the

winter months each year compared with non winter months; so called excess winter deaths (EWD) months; so called excess winter deaths (EWD)

• Estimated that for every death there are an additional

eight non fatal hospital admissions eight non fatal hospital admissions

• Temperature only has to drop below about 6C for death

rates to rise a es o se

• The effect lasts for weeks
• The UK has more EWD than most other western

The UK has more EWD than most other western European countries

International comparisons International comparisons

Fuel Poverty trends England 2003 13 Fuel Poverty trends England 2003-13

2003 20 3 2003 2013 2.44M (11.8 %) Households living in fuel poverty n (%) 2.35M (10.4%) 1.22M (50.5 %) Owner occupied houses in fuel poverty 1.10M (47%) 483K Private rented houses in fuel poverty 816K 483K (20 %) Private rented houses in fuel poverty 816K (34.8 %) 496K (20%) Local Authority properties 193K (8 2%) (20%) (8.2%) 215K 8.9% Housing Association Properties 234K (10%) 857K Households in fuel poverty where oldest resident 60 or over 542K

S A l f l t t ti ti t 2015 DECC d N ti l St ti ti Source: Annual fuel poverty statistics report 2015, DECC and National Statistics

The monetary costs The monetary costs

• Age UK have estimated that “the annual cost to the NHS

in England of cold homes is £1.36 billion”, not to mention the associated cost to social care services which is the associated cost to social care services, which is likely to be substantial.

• This is made up of the costs of hospital admission A&E

This is made up of the costs of hospital admission, A&E attendance, additional GP and community nurse visits etc.

• Costs to families and carers also considerable

Causes and vulnerable people Causes and vulnerable people

• People with cardiovascular (40%) or respiratory diseases

(33%) P l ith t l h lth diti

• People with mental health conditions
• People with disabilities

Old l ( 65 d i ll 75)

• Older people (>65 and especially >75)
• Households with young children

P

• Pregnant women
• People on low income and especially those in fuel

t poverty A d f bi ti f th b And of course combinations of the above

How NICE works How NICE works

• Defined “scope” based on referral and consultation
• Reviews of evidence of effectiveness and economics

(L d S h l f H i d UCL) (London School of Hygiene and UCL)

• Best available evidence, including testimony

P bli H lth Ad i C itt di i

• Public Health Advisory Committee discussions
• 3 month public consultation on draft guidance

O bli i d k h ld bl

• Open process; public meetings and stakeholders able to

comment at each stage Fi l id bli h d 5 M h 2015

• Final guidance published 5 March 2015

The evidence The evidence

• The nature of evidence – research literature; testimony
• Confirmed a clear link between cold weather and

i i ill d d th increase in illness and death

• Strong inference that tackling cold homes and fuel

poverty will reduce excess deaths and illness poverty will reduce excess deaths and illness

• Interventions often short term, confusing and not “joined

up” up

• Variation in practice, with many examples of innovation

and good practice and coordinated local initiatives and good practice and coordinated local initiatives

• Some limitations to the evidence

The recommendations The recommendations

Thirteen quite detailed recommendations so key points:

• Make cold homes part of planning by Health and

W llb i B d J i t St t i N d A t Wellbeing Boards; Joint Strategic Needs Assessment

• Single-point-of-contact health and housing referral

service providing service providing

– Information on risks, on what help is available, access to tailored housing/energy efficiency interventions and grants g gy y g and advice on benefits, fuel options, debt management etc.

• Identify people at risk of ill health from cold homes

– Use existing data sources, record the risk and share information across agencies(with safeguards)

A case study A case study

A community nurse visited an elderly gentleman with severe respiratory disease He was on a continuous oxygen supply driven by an electric

• disease. He was on a continuous oxygen supply driven by an electric
• pump. She asked him about his electricity contract and learned that he

was on a pre-payment meter and had to go out to top up his credit at l t k least once a week. The nurse had just been on a training course about cold homes and The nurse had just been on a training course about cold homes and health so knew that the local health and housing service could help him and therefore referred him. An adviser worked with him to get him onto a better tariff, helped him claim unclaimed pension credit, get him onto his energy suppliers emergency list to ensure a continuous supply (of electricity and

• xygen!) and saved him several hundred pounds a year.

Source : Centre for Sustainable Energy Sou ce Ce t e o Susta ab e e gy

Recommendations (2) Recommendations (2)

• Health and social care professionals (and others visiting

vulnerable people) should “make every contact count”

Think about heating and housing needs when seeing – Think about heating and housing needs when seeing patients/clients in vulnerable groups, provide information about the risks and the help available and be aware that needs may be hidd hidden

• Don’t discharge people from hospital to cold homes

Assess need for immediate and longer term action in advance of – Assess need for immediate and longer term action in advance of

• discharge. Consider referral but don’t delay discharge.
• Harness the non-health and social care work force (such

( as heating engineers and meter installers) going into homes to identify people at risk, advise them and refer appropriately.

Recommendations (3) Recommendations (3)

• Training of health and social care staff, housing and

voluntary sector workers and technical staff

In the health risks of cold homes what can be done to mitigate – In the health risks of cold homes, what can be done to mitigate them and how to help clients sensitively and effectively

• Raise awareness among professionals and the public

g p p about how to keep warm at home.

– Publicity depends on central and local leadership and drive – DECC DH PHE HWB d L l A h i i DECC, DH, PHE, HWBs and Local Authorities

• Make sure buildings meet ventilation and other building

and trading standards and trading standards

– Through enforcement of existing powers; don’t make things worse.

Research recommendations Research recommendations

• Studies into the effect of cold homes on the rate of

illness as well as death and multiple vulnerabilities. Q tit ti d lit ti h i t th b i

• Quantitative and qualitative research into the barriers

and facilitators for action and coping strategies – e.g. self disconnection disconnection.

• Studies specifically designed to test the effectiveness

and cost effectiveness of interventions to tackle cold a d cos e ec e ess o e e

• s o ac e co d

homes and fuel poverty.

• What is the relationship between improved energy

p p gy efficiency and its impact on indoor temperature?

Conclusions Conclusions

• There is much that can be done.
• Several potentially congruent policy initiatives which

ld b t l t f di t d l l ti could be catalysts for coordinated local action:

– Cold weather plan, environmental policies to reduce fuel use, drive for energy efficiency and the reduction of fuel poverty, d e o e e gy e c e cy a d t e educt o

• ue po e ty,

benefits programmes

• Public Health within LAs should be an asset
• National policy provides framework but local action and

especially coordination is key.

Acknowledgements Acknowledgements

• NICE staff, review staff (London School of Hygiene and

T i l M di i d UCL) PHAC ll d Tropical Medicine and UCL), PHAC colleagues and expert witnesses

• Guidance available at www.nice.org.uk and follow the

links to NG6 Excess winter deaths and morbidity and the health links to NG6 Excess winter deaths and morbidity and the health

risks associated with cold homes

And finally And finally

A question for you Are you confident that all households in your area and especially those at greatest risk of cold-induced harm have easy access to advice and services which will help mitigate easy access to advice and services which will help mitigate those risks?